Immunomodulatory Therapy for Neuropathic Pain

主要研究者/项目负责人（末、中、首：陈日东 项目摘要 超过2500万美国人患有慢性疼痛。由于缺乏其他治疗方法， 过度依赖阿片类药物，导致阿片类药物过量成瘾和死亡的惊人流行。新的 风湿性疼痛难以治疗，只有30-40%的患者达到有意义的（>40-50%）疼痛缓解。电流 治疗（例如，度洛西林和加巴喷丁）主要通过阻断神经传递来解决症状。 在疼痛通路中锡永有限的功效、严重的副作用和狭窄的治疗指数。因此，小说 迫切需要非阿片类药物治疗来安全地控制症状，并针对潜在的病理学- 这将改善受影响患者的功能状态和生活质量的免疫学机制。 最近已经表明，CD 4 + Th 1是神经性疼痛发展的主要参与者。白细胞介素-2 （IL-2）是调节性T细胞通过直接结合其受体而产生、存活和发挥功能的关键细胞因子。 高亲和力受体。低剂量rIL-2治疗增加抗炎调节性T细胞和M2型 巨噬细胞和抑制病原性干扰素β分泌T辅助1型细胞。这种rIL-2治疗是 在人类自身免疫性疾病的临床研究中有效，无并发症或感染。因此，恢复- 用低剂量IL 2定量或增强调节性T细胞可能提供一种新的预防和治疗策略， 神经性疼痛的治疗。然而，目前的低剂量rIL 2疗法存在几个缺点，包括 半衰期短，体外聚集的倾向导致注射部位的不良局部反应， 狭窄的治疗窗口我们已经设计了专有的基于IL 2的变体，这将使选择性刺激， 具有延长的半衰期和宽的治疗窗的TdR的测定。在第一阶段研究中，我们成功地 确定了命名为APT 603的变体，它选择性刺激调节性T细胞并提供强大的免疫功能。 在大鼠单神经病慢性压迫性损伤模型中的镇痛功效具有优异的安全性 profile.凭借经验丰富的药物开发团队，我们建议在两个孔中确定剂量反应- 建立了具有不同病理生理学的神经病理性疼痛模型，并进行必要的关键活动， 启用APT 603的IND备案。 具体目的1：确定APT 603消除STE-1中神经性疼痛的治疗指数。 诱导的（T1 D）糖尿病大鼠和坐骨神经慢性压迫性损伤（CCI）大鼠模型。 具体目标2：生产cGMP（现行药品生产质量管理规范）等级APT 603。 具体目标3：评估APT 603的非临床安全性。 长期目标是将候选药物开发为安全和改善疾病的镇痛疗法。 每周一次或每两周一次给药将为患者提供持续的神经性疼痛缓解，而不会诱导显著的神经性疼痛。 副作用、耐受性或成瘾性。

Principal Investigator/Program Director (Last, First, Middle: Ridong Chen Project Summary More than 25 million Americans suffer from chronic pain. Due to the lack of other treatments, there has been an overreliance on opioids, contributing to an alarming epidemic of opioid overdose addictions and deaths. Neu- ropathic pain is difficult to treat, with only 30-40% of patients achieving meaningful (>40-50%) pain relief. Current therapies (e.g., duloxeline and gabapentin) mainly address symptoms by focusing on blocking neurotransmis- sion in the pain pathway with limited efficacy, severe side effects, and narrow therapeutic indices. Hence, novel non-opioid therapies are urgently needed to safely manage symptoms and also target the underlying pathophys- iological mechanisms that will improve the functional status and quality of life of affected patients. It has been recently shown that CD4+ Th1 is a major player for neuropathic pain development. Interleukin-2 (IL-2) is the key cytokine for the generation, survival, and function of regulatory T cells by direct binding to its high affinity receptor. Treatment with low-dose rIL-2 increased anti-inflammatory regulatory T cells and M2 type macrophages and inhibited pathogenic interferon- secreting T helper type 1 cells. This rIL-2 treatment was efficacious in human clinical studies for autoimmune diseases without complications or infections. Hence, resto- ration or enhancement of regulatory T cells with low-dose IL2 may offer a novel strategy for prevention and treatment of neuropathic pain. However, several drawbacks exist for current low-dose rIL2 therapy, including a short half-life, propensity for in vitro aggregation causing adverse local reaction at injection sites, and a potential narrow therapeutic window. We have designed proprietary IL2-based variants that will enable selective stimu- lation of Tregs with an extended half-life and a broad therapeutic window. In the Phase I study, we successfully identified the variant, designated APT603, which selectively stimulates regulatory T cells and provides robust analgesic efficacy in the chronic constriction injury model of mononeuropathy in rats with an excellent safety profile. With an experienced drug development team, we propose to determine dose responses in two well es- tablished models of neuropathic pain with distinct pathophysiology and to conduct critical activities necessary to enable IND filing for APT603.  Specific Aim 1: Determine the therapeutic index of APT603 for abrogating neuropathic pain in STE- induced (T1D) diabetic rats and in a rat model of sciatic nerve chronic constriction injury (CCI).  Specific Aim 2: Manufacture cGMP (Current Good Manufacturing Practice) grade APT603.  Specific Aim 3: Evaluate the nonclinical safety of APT603. The long-term goal is to develop the drug candidate as a safe and disease-modifying analgesic therapy. Weekly or bi-weekly dosing will provide sustained neuropathic pain relief for patients without inducing significant side effects, tolerance, or addiction.